Filtering by Tag: technology

Does Your Healthcare Tech Product Fuel the "Alarm Fatigue Syndrome"?

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Data is good. More data is better. At least that’s what some people think. Although there is some truth to that position, at some point, too much information leads to overload. There is a difference between the volume and the value of data, and more data doesn’t automatically lead to better patient or operational outcomes.   

In an interview published in the April 30, 2018 issue of Modern Healthcare, Allscripts CEO Paul Black discussed data that is not properly managed, harmonized and de-duplicated. His comments referred to assimilating Big Data feeds that incorporate information from several sources, but his remarks apply to all of healthcare data. “It’s like reading the New York Times, Wall Street Journal, and C-Span all at once,” he said.  Without an interpretive framework, data is just noise.

Anyone who has spent any time in either an inpatient or Emergency Department setting has heard numerous alarms happily chirping in the background and being ignored by virtually everyone. Many electronic gizmos that are part of patient care these days sport alarms to alert caregivers when some kind of threshold is exceeded. And these thresholds are exceeded regularly. By many devices. And they are regularly ignored. If everything becomes urgent, nothing is urgent.

When medication management software for physicians first hit the market, there were so many low threshold alerts about dosing and potential interactions that many physicians learned to click right through them and essentially ignore most of them, defeating the alerts’ purposes. In some cases, they missed truly important warnings resulting in patient harm.

Patients may think it’s wonderful that their primary care physician can access the steady stream of heartrate and other biometric data from their fitness monitors, but no physician has the time to sort through tons of undifferentiated data. Even getting a condensed daily feed of summary data can be overwhelming unless there is an analytical overlay to alert the clinician when action is required. The best apps provide clear alert systems (e.g., color-coding patients as green, yellow or red) so someone from the physician’s staff can immediately identify the patients that require immediate attention.

Recommendations: 

  • If you are vendor offering a product that greatly increases data flow to physicians or hospitals, be sure to solicit input from relevant clinicians concerning the types of information that are truly helpful. 

  • You must include an analytical framework that provides immediately identifiable intervention thresholds. 

  • Incorporate the ability to conveniently modify alert thresholds so clinicians can customize notifications to match their preferences.

  • Develop mechanisms that guide clinicians toward suitable interventions so they can easily step in. Remember that beyond being valid, data must also be actionable.

  • As you are presenting your product, make sure you communicate that you understand the difference between volume of data and value of data that has been curated.

Disruptive Technology, 1934-Style

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What an unexpected pleasure to see one of my “must see” items earlier this month while I was in Chicago for an ACHE Exam Committee meeting.  My wife and I stayed for an extra day and visited the terrific Museum of Science and Industry where the first thing we saw upon entering was the famous Pioneer Zephyr train that revolutionized rail travel. I had seen pictures of this beautiful train for years but didn’t know it is still around.

The year was 1934, and conventional locomotives – “iron horses” – were heavy and slow. But on May 24, a new Art Deco-style train left Denver for a record-breaking trip to Chicago, cutting the time almost in half to just over 13 hours. Historians credit the Pioneer Zephyr with revitalizing the train travel industry and boosting the streamlining craze.  

In a sense, the designers of Pioneer Zephyr didn’t invent anything new. Instead, they combined four other breakthrough technologies in a way that no one else had before. These four were:

  • Using a diesel-electric motor

  • Replacing heavy iron with light-weight aluminum

  • Applying principles of streamlining

Designing cars with shared undercarriage wheels, reducing the number of wheel trucks and saving considerable weight.

The result was an ultra-sleek train weighing only about one-eighth as much as a comparable conventional train. Incredibly, the diesel engine was able to pull the four full-sized train cars with an output of only 600 horsepower. (As a point of reference, that’s less than the 2019 C7 Corvette’s 650 horsepower motor.) But by combining diesel technology with lightweight aluminum, streamlining principles, and an innovative undercarriage structure, the designers were able to upend an industry and relegate steam locomotives to the history books.

This is typical of many technology disruptions. Some innovations are true ground-up breakthroughs, but many of the most significant breakthroughs involve tapping into other innovative technologies and applying them in revolutionary ways. Apple didn’t invent the mobile phone or the tablet, but it figured out the critical functional and customer-desired elements that propelled those devices to the must-have category.

Developers of health-related apps aren’t reinventing the Internet, using new IT communications protocols, or creating brand new devices. Instead they’re using the smartphones and tablets patients already have, identifying a legitimate need, and applying these existing technologies in creative and cost-effective ways.

I tell my clients that, individually, no breakthrough is such a blockbuster that it will single-handedly totally transform the healthcare system. Because of the Pioneer Zephyr, train travel in the 1940s bore little resemblance to its 1930 counterpart. Similarly, with hundreds and even thousands of successful health tech innovations introduced each year, the healthcare system of 2028 may look totally different from today’s. I consider it an honor to be playing a small role in helping bring exciting breakthroughs to the market.

May you and your family experience all of God’s blessings during this special season and in 2019.

Getting Ready to Launch a New Product? Don't Make Either of These Timing Mistakes

Developers and entrepreneurs spend months or even years preparing their product for market introduction. A danger they face is misjudging when to launch. They must heed the old saying, “You only have one chance to make a first impression,” but some may obsess over this too much and, therefore, delay their product’s introduction longer than necessary. This can lead to losing the first-in-market advantage and/or missed sales. However, in an attempt to beat the rest of the market, other vendors make the mistake of launching prematurely, with sometimes-devastating results.   

Do you remember Apple’s disastrous 2012 launch of its new Maps app? It worked perfectly unless you didn’t want to have to find a train station in the middle of lake or were confused by aerial-view interstate maps that resembled overcooked spaghetti. Once a product gets cast as inferior, it can take years to recover. Some never do.

In order to avoid this mistake, some companies overcompensate and wait too long. This potentially creates two problems:

·         If your product is groundbreaking or transformational, a delay gives competitors extra daylight, and you could forfeit your “first to market” advantage.

·         Delays slow down cash flow, something which can prove fatal to a cash-starved startup.

Recommendation:  If you are introducing a groundbreaking service or product, seek the sweet spot where your minimally viable product performs all its essential functions adequately yet still gives you a head start in the market. A product that does exactly what it purports to do – even if it’s not particularly fancy – establishes your credibility and starts the cash flow so vital to continued development. If early adopters like what they see, they will likely talk your product up among their peers.

Vendors' 3 Most Common ROI Mistakes - Part 2

Last time, I presented the first of three fallacies vendors often succumb to in their ROI projections to potential clients, namely the idea that saving time in a worker’s day results in cost savings to the hospital.  The typical methodology they use is identifying a certain number of minutes per procedure the new approach will save, multiplying the time saved by the number of procedures per day that job function performs, and then multiplying the result by annual salary plus benefits.  Viola!  Savings.

Not so fast.  As I pointed out, very rarely will a worker be sent home after seven hours and 45 minutes (instead of working a full eight-hour shift), thereby truly reducing costs.  When I point this out, the vendor typically counters by stating there is value in freeing up someone’s time to perform other neglected tasks.  True, but that doesn’t save a dime.

The example from last time concerned a vendor who had a product he claimed would save physical therapists’ time.  He was a little rattled after I explained Fallacy #1, so his next line of reasoning was, “Well, even you don’t send the therapist home early, reducing the time per procedure ends up increasing the therapist’s capacity so he can see more patients and bring in new revenue.” 

Fallacy #2

Nice thought – if the facility is literally turning patients away due to capacity constraints.  That may hold true in for some clinical areas, but it’s certainly not universally true across all hospital services.  Depending on the service line, some providers may be idle for parts of their days due to low patient volume.  So increased efficiency doesn’t necessarily mean bringing in new patients, meaning incremental revenue will probably not materialize.

There is a further complication to the “increased throughput argument.”  There may be other staff involved in a clinical or operational process who wouldn’t be directly affected by the positive effect of the new technology.  A good example relates to Operating Room schedules.  Even if a technology saves a few minutes per procedure for the surgeon, those saved minutes evaporate if housekeeping is understaffed and can’t turn the room can’t over quickly enough to slip in an additional procedure.  

So increasing patient throughput is Fallacy #2.

What It Takes to Avoid Fallacy #2

·         A revenue-producing service where the hospital is literally turning away patients due to capacity limitations

·         No other volume-based bottlenecks in related service areas

So demonstrating credible and persuasive ROI numbers is harder than it seems.

Who's Afraid of the Big Bad Breach? - Part 1

You should be.  It’s not a matter of “if.”  It’s a matter of “when.”  Cybercrime had become such a huge industry that cybersecurity experts agree that hospitals should count on eventually becoming a victim.

This week’s blog will present some disturbing statistics and some vulnerability points, and the next installment will outline some risk mitigation strategies.

Here are some recent notorious breaches:

·         Yahoo! – 1,000,000,000 accounts

·         LinkedIn – 165,000,000 accounts

·         Target – 110,000,000 accounts

·         DropBox – 68,000,000 accounts

·         Home Depot – 54,000,000 credit cards compromised

·         Sony Pictures Entertainment – Significant exposure of their inner workings and data

And who can forget the infamous hacking of the Democratic National Committee’s servers?

If these “household name” organizations were unable to adequately defend themselves, why would a hospital or healthcare vendor think they are immune?  Experts estimate that hacked medical information is worth 10x to 20x that of hacked financial records.  For one thing, medical data cannot be easily changed.  Also the medical data often also includes social security numbers and credit card information.  Physician practices and smaller hospitals may think they are less likely to be hacked because of their relatively smaller pool of data.  However, hackers sometimes target them specifically because they assume they have fewer defensive resources and are, therefore, easier to attack.

Modern Healthcare had an extensive special report called “Building a Better Cyberdefense” in its January 23, 2017 issue.  Consider these statistics:

·         There were 8-1/2 times more healthcare breaches in 2016 than in 2006.

·         87% of healthcare attorneys believe that their clients are at greater risk than other industries.

·         At 78,800,000, the March 2015 breach of Anthem wins the prize for the largest healthcare breach ever.

And let’s not forget one of the newest threats:  ransomware.  Hollywood Presbyterian Medical Center’s patient data was recently held hostage until it paid $17,000 to restore it.

Most people consider the biggest threats external hackers who conduct direct attacks, seek vulnerabilities created by patches or interfaces among various internal systems, or intrude through connected medical devices and other parts of the “Internet of Things.”  They are clearly sources of major risk.  But the highest percentage of breaches are actually caused by internal sources such as disgruntled employees, sloppy actions by employees who are lured by phishing or other attacks, and lost laptops or other devices. 

Or how about the threat vector called “shadow IT”?  In order to bypass the hassle of layered security requirements, some hospital staff (including clinicians) may log onto the hospital’s public Wi-Fi system, thereby potentially exposing any protected health information on their machines.  That reminds me of one of my favorite sayings:  It’s hard to design a foolproof system because fools are so ingenious.

Some may think the answer is to minimize their exposure through limiting technology.  This is unlikely to help since every organization with any type of technology such as internal computer systems or electronic medical records is already vulnerable.

So what’s a hospital to do?  The next installment will offer some strategies.